895 resultados para leon
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Contient : Listes de manuscrits de Colbert ; « Catalogue des livres de M. Puget, que M. d'Aguesseau m'a envoyé le 2 mars 1677. » ; Lettre de M. de Reichacq (?) à Baluze (Toulouse, 10 juin 1671) ; Extraits du catalogue de la bibliothèque d'Heinsius ; « Inventario delli libri mss. consegnati in Roma dall'illustrissima sigmarchesa de Bagni al Benedetti, per mandare al Em. Card. Mazarin » (20 janvier 1649), remis à M. Colbert, à Sedan, le 10 août 1657 ; Leçon d'ouverture du cours de droit canon fait par Baluze au Collège royal en 1690 ; Notes pour le commentaire du Décret de Gratien
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IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves. MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class. RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008). CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.
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Defensins are natural endogenous antimicrobial peptides with potent anti-HIV activity and immuno-modulatory effects. We recently demonstrated that immature dendritic cells (DC) produce α-defensins1-3 and that α-defensins1-3 modulate DC generation and maturation. Since DC-HIV interaction plays a critical role during the first steps of HIV infection, we investigated the possible impact of α-defensins1-3 production by DC on disease progression.
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Compte tenu des relations étroites existant entre le pouvoir politique et l'histoire - et plus particulièrement l'enseignement de l'histoire à l'école - , les manuels constituent un objet d'étude privilégié de l'évolution des relations pouvoir/enseignement. Ils fournissent un lieu de médiation privilégié entre les savoirs savants et les savoirs scolaires institutionnels ; ils permettent d'observer les conceptions didactiques préconisées par l'institution scolaire. Si, sous l'égide de l'Etat-nation au 19e siècle, les savoirs savants historiques et les savoirs scolaires étaient entremêlés, les rapports se sont complexifiés durant le 20e siècle en raison notamment de la prise de distance progressive de l'histoire savante à l'égard du pouvoir. Petit à petit, à partir des années 1930, le concept d'histoire- problème, initié par l'école historique des Annales, dépasse l'histoire-récit de l'école historique positiviste (méthodique) du 19e siècle et sa traduction du récit- national au coeur de la leçon d'histoire. Cependant, si après 1945, l'école des Annales, puis la Nouvelle histoire, tendent à s'imposer dans le champ de l'histoire savante francophone, elles se heurtent à une tradition scolaire bien établie et modifient peu et tardivement les curricula, les manuels et les pratiques enseignantes. Progressivement donc, une fracture apparaît entre l'histoire savante et l'histoire scolaire. Dans cette étude, notre travail envisage l'analyse du manuel d'histoire en tant qu'objet hybride. Il est à la fois porteur d'un texte historien, ouvrage de vulgarisation et de référence, ainsi qu'outil pédagogico-didactique. Par ailleurs, le manuel d'histoire a la charge de transmettre des valeurs, car les finalités attribuées par l'autorité politique, via les autorités scolaires, à l'histoire scolaire comportent toujours une dimension forte de formation du futur citoyen. Au texte de départ sont associés des documents textuels ou iconiques, des résumés, des questions regroupées par chapitre, un glossaire ou une chronologie générale. De plus, ce texte est encadré d'un dispositif didactique plus ou moins explicite : préface, numérotation par paragraphe correspondant à la leçon du jour, dates mises en évidence, aide-mémoire et questions. Par ailleurs, les découpages en livres ou en parties peuvent correspondre à des années (ou parties d'années) de programme. Il sera donc également étudié pour les spécificités d'un sous-genre de discours à définir : les manuels - d'histoire - produits (et utilisés) dans le canton de Vaud au 20e siècle. En conséquence, notre travail se propose d'observer et d'analyser les manuels d'histoire vaudois sous deux modalités préférentielles. Premièrement, celle des formes constitutives et évolutives prises par le manuel pour se construire comme un discours légitimé (deuxième partie : écriture et mise en scène de l'histoire). Deuxièmement, celle de la mise en scène d'une histoire à visée pseudo- pédagogique masquant l'intégration du discours de l'autorité politique (troisième partie : comment l'autorité vient au discours). Site internet : http://manuelshistoire.ch
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The CIAO Study is a multicenter observational study currently underway in 66 European medical institutions over the course of a six-month study period (January-June 2012).This preliminary report overviews the findings of the first half of the study, which includes all data from the first three months of the six-month study period.Patients with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study.912 patients with a mean age of 54.4 years (range 4-98) were enrolled in the study during the first three-month period. 47.7% of the patients were women and 52.3% were men. Among these patients, 83.3% were affected by community-acquired IAIs while the remaining 16.7% presented with healthcare-associated infections. Intraperitoneal specimens were collected from 64.2% of the enrolled patients, and from these samples, 825 microorganisms were collectively identified.The overall mortality rate was 6.4% (58/912). According to univariate statistical analysis of the data, critical clinical condition of the patient upon hospital admission (defined by severe sepsis and septic shock) as well as healthcare-associated infections, non-appendicular origin, generalized peritonitis, and serious comorbidities such as malignancy and severe cardiovascular disease were all significant risk factors for patient mortality.White Blood Cell counts (WBCs) greater than 12,000 or less than 4,000 and core body temperatures exceeding 38°C or less than 36°C by the third post-operative day were statistically significant indicators of patient mortality.
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The observation that real complex networks have internal structure has important implication for dynamic processes occurring on such topologies. Here we investigate the impact of community structure on a model of information transfer able to deal with both search and congestion simultaneously. We show that networks with fuzzy community structure are more efficient in terms of packet delivery than those with pronounced community structure. We also propose an alternative packet routing algorithm which takes advantage of the knowledge of communities to improve information transfer and show that in the context of the model an intermediate level of community structure is optimal. Finally, we show that in a hierarchical network setting, providing knowledge of communities at the level of highest modularity will improve network capacity by the largest amount.
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Defensins are natural endogenous antimicrobial peptides with potent anti-HIV activity and immuno-modulatory effects. We recently demonstrated that immature dendritic cells (DC) produce α-defensins1-3 and that α-defensins1-3 modulate DC generation and maturation. Since DC-HIV interaction plays a critical role during the first steps of HIV infection, we investigated the possible impact of α-defensins1-3 production by DC on disease progression.
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Introduction: Prior clozapine studies indicated no effects, mild inhibition or induction of valproic acid (VPA) on clozapine metabolism. The hypotheses that (i) VPA is a net inducer of clozapine metabolism, and (ii) smoking modifies this inductive effect were tested in a therapeutic drug monitoring study. Methods: After excluding strong inhibitors and inducers, 353 steady-state total clozapine (clozapine plus norclozapine) concentrations provided by 151 patients were analyzed using a random intercept linear model. Results: VPA appeared to be an inducer of clozapine metabolism since total plasma clozapine concentrations in subjects taking VPA were significantly lower (27% lower; 95% confidence interval, 14-39%) after controlling for confounding variables including smoking (35% lower, 28-56%). Discussion: Prospective studies are needed to definitively establish that VPA may (i) be an inducer of clozapine metabolism when induction prevails over competitive inhibition, and (ii) be an inducer even in smokers who are under the influence of smoking inductive effects on clozapine metabolism.
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Fundamentando-se na Teoria Crítica da Sociedade, analisa-se como o discurso em prol da formação para a autonomia se consubstancia em propostas de prática pedagógica para os anos iniciais do ensino fundamental. Foram analisados cinco livros para o 5º ano do ensino fundamental, de diferentes áreas. Observou-se que, para formar sujeitos autônomos, contraditoriamente, as propostas diluem a autoridade do professor e a obrigatoriedade da transmissão do conhecimento; visando a formar para a convivência pacífica, priorizam-se trabalhos em grupos; para formar cidadãos participativos, os alunos devem propor soluções para problemas da comunidade. Tais propostas concorrem para a falsa autonomia e a falsa criticidade, expressão da pseudoformação a que todos estão submetidos na sociedade atual.
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Human tumors often contain slowly proliferating cancer cells that resist treatment, but we do not know precisely how these cells arise. We show that rapidly proliferating cancer cells can divide asymmetrically to produce slowly proliferating "G0-like" progeny that are enriched following chemotherapy in breast cancer patients. Asymmetric cancer cell division results from asymmetric suppression of AKT/PKB kinase signaling in one daughter cell during telophase of mitosis. Moreover, inhibition of AKT signaling with small-molecule drugs can induce asymmetric cancer cell division and the production of slow proliferators. Cancer cells therefore appear to continuously flux between symmetric and asymmetric division depending on the precise state of their AKT signaling network. This model may have significant implications for understanding how tumors grow, evade treatment, and recur.
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Foram avaliados os efeitos da seleção recorrente intrapopulacional e da oscilação genética na população de milho (Zea mays L.) SA3 tolerante a solos ácidos, submetida a 20 ciclos de seleção. Utilizaram-se amostras de oito ciclos seletivos, com o objetivo de estimar as respostas à seleção para produção de grãos e outros caracteres agronômicos, utilizando o modelo proposto por Smith (1983). O material genético utilizado consistiu em oito ciclos per se, oito ciclos per se autofecundados, 28 F1's entre ciclos, 28 F1's entre ciclos autofecundados e 28 F1's recombinados. Os experimentos foram conduzidos em cinco ambientes com solos ácidos, no Brasil e na Colômbia. As magnitudes das respostas esperadas à seleção (2ALI+2DLI) mostraram que os esquemas seletivos utilizados não foram eficientes para melhorar o caráter produção de grãos e para reduzir o caráter altura da planta. Porém, as estimativas indicaram que o processo de seleção foi eficiente para reduzir o número de dias para o florescimento feminino e aumentar o número de espigas por planta. As magnitudes das estimativas da oscilação genética (DQI) mostraram que seus efeitos não limitaram o melhoramento dos diferentes caracteres.
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Water-surface-elevation profiles and peak discharges for the floods of September 15-16, 1992, in the Thompson, Weldon, and Chariton River Basins, south-central Iowa, are presented in this report. The profiles illustrate the 1992 floods along the Thompson, Weldon, Chariton, and South Fork Chariton Rivers and along Elk Creek in the south-central Iowa counties of Adair, Clarke, Decatur, Lucas, Madison, Ringgold, Union, and Wayne. Water-surface-elevation profiles for the floods of July 4, 1981, along the Chariton River in Lucas County and along the South Fork Chariton River in Wayne County also are included in the report for comparative purposes. The September 15-16, 1992, floods are the largest known peak discharges at gaging stations Thompson River at Davis City (station number 06898000) 57,000 cubic feet per second, Weldon River near Leon (station number 06898400) 76,200 cubic feet per second, Chariton River near Chariton (station number 06903400) 37,700 cubic feet per second, and South Fork Chariton River near Promise City (station number 06903700) 70,600 cubic feet per second. The peak discharges were, respectively, 1.7, 2.6, 1.4, and 2.1 times larger than calculated 100-year recurrence-interval discharges. The report provides information on flood stages and discharges and floodflow frequencies for streamflow-gaging stations in the Thompson, Weldon, and Chariton River Basins using flood information collected through 1995. Information on temporary bench marks and reference points established in the Thompson and Weldon River Basins during 1994-95, and in the Chariton River Basin during 1983-84 and 1994-95, also is included in the report. A flood history summarizes rainfall conditions and damages for floods that occurred during 1947, 1959, 1981, 1992, and 1993.